ABSTRACT
We present the case of a 30-year-old female suffering from a type five maturity onset diabetes of the young deficiency, resulting in type 1 diabetes and terminal renal insufficiency. She also had chronic and refractory pruritis due to primary sclerosing cholangitis-like fibrosis. She underwent combined en bloc liver and pancreas transplantation and kidney transplantation. The postoperative course was complicated by a gastric outlet obstruction due to compression of the native gastroduodenal junction by the donor aortic tube. This was treated by construction of a roux-en-Y gastrojejunostomy at posttransplant day 24. To our knowledge, compression of the gastroduodenal junction by a donor aortic tube after combined liver and pancreas (or multivisceral) transplantation has not been reported previously.
Subject(s)
Aorta/surgery , Blood Vessel Prosthesis Implantation/adverse effects , Cholangitis, Sclerosing/surgery , Diabetes Mellitus, Type 1/surgery , Gastric Outlet Obstruction/etiology , Liver Transplantation/adverse effects , Pancreas Transplantation/adverse effects , Adult , Anastomosis, Roux-en-Y , Cholangitis, Sclerosing/complications , Cholangitis, Sclerosing/diagnosis , Diabetes Mellitus, Type 1/complications , Diabetes Mellitus, Type 1/diagnosis , Diabetic Nephropathies/etiology , Diabetic Nephropathies/surgery , Female , Gastric Bypass , Gastric Outlet Obstruction/diagnosis , Gastric Outlet Obstruction/surgery , Humans , Kidney Transplantation , Renal Insufficiency/etiology , Renal Insufficiency/surgery , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
We present the case of a 74-year-old man with a pulsatile somatosound causing insomnia and day-time irritation. Given the lack of salvation after medical therapy the patient went in search for a solution and found it in a tennis ball and radio. In this case, the somatosound was due to an extracranial arteriovenous malformation, but the differential diagnosis of pulsatile somatosounds is quit extended, ranging form vascular disorders to tumoral processes. This makes these cases challenging for all caretakers.
